Wednesday, July 25, 2012

BCBST Out-of-pocket maximum met before deductible

Recently, my company, Oncologics, was acquired by another company, e+CancerCare, and in the process our health insurance company was changed from Gilsbar to Blue Cross/Blue Shield of Tennessee (BCBST). I'll not go into my feelings on this transition right now (they are mixed, although I feel better about the switch now than when I initially learned the details of the new plan). However, I have found something interesting.

Our plan is a high-deductible health plan, with an annual (in-network) deductible of $5,000. It also has an out-of-pocket (OOP) maximum of $5,000 (that is, the same as the deductible). What is interesting is that certain things we pay for do not count towards the deductible, but do count towards the out-of-pocket maximum. Actually, I've only found one thing so far in this category, and that is co-payments for drugs on the preventive drug list (which are covered 100% after a copay, without needing to meet the deductible). Megan filled a prescription for one of these drugs, and paid a $25 copay. This amount was applied to our OOP max, but not our deductible.

We had other medical expenses that fulfilled the remainder of our deductible and OOP amounts, and so now pay nothing to go to the doctor or fill a prescription. However, as you can see in the picture, BCBST still has us needing another $25 to fulfill our deductible. It is interesting because we will never meet the remainder of our deductible this year, yet everything will be paid for at 100%. This is a byproduct of the OOP max being the same as the deductible, without an area between the two where costs are shared between the insurance and the patient.



On an aside, snag.gy is pretty cool.

EDIT: 6/6/2016 - Well, I guess Snag.gy is not a good location for long term storage of pictures (lol, I probably could have guessed that!). I'll have to remember that in the future.